碧兰麻在口腔临床的应用

碧兰麻作为一种新型的酰胺类口腔专用局麻药 ,其麻醉效能高、起效快、毒性低 ,可广泛应用于口腔临床治疗 ,麻醉效果明显好于利多卡因或普鲁卡因 ,本文对碧兰麻在口腔临床各科的应用效果作一综述。     

碧兰磨在儿童牙科临床应用的初步观察

目的 探讨碧兰麻在儿童牙科治疗中的作用。方法 对200你拔牙患者，100例牙髓治疗患者采用碧兰麻局麻，使用Visal ANalogue Scale法评价^[1]。结果 使用碧兰麻局麻下拔牙，患者评价麻醉效果1级82%，2级15%，3级3%，牙髓治疗组1级85%，2级10%，3级5%。结论 碧兰麻用于局部麻醉显效快，效果明显，可以使儿科治疗真正达到无痛。     

阿替卡因与利多卡因在磨牙牙髓治疗中镇痛效果的比较

目的：研究阿替卡因与利多卡因对牙髓的麻醉效果。方法：对246例病人的382个患牙分别用碧兰麻（40g／L阿替卡因加1：100000的肾上腺素）和20g／L盐酸利多卡因加1：100000的肾上腺素进行局部浸润麻醉，观察牙髓麻醉效果。对麻醉失败者改用阻滞麻醉继续观察。结果：上颌磨牙浸润麻醉，阿替卡因与利多卡因的麻醉效果无差别；下颌磨牙浸润麻醉，阿替卡因的效果略优于利多卡因。但对浸润麻醉失败的病例改用阻滞麻醉后，两者的麻醉效果无明显差别。结论：阿替卡因和利多卡因麻醉的镇痛效果近似，麻醉方式在镇痛中起到更重要的作用。     

碧兰麻在急性牙髓炎治疗中麻醉效果观察

目的 观察碧兰麻麻醉牙髓的临床效果。方法 把急性牙髓炎患牙随机分为2组,分别使用碧兰麻和利多卡因,对照观察2种麻醉剂的麻醉效果。结果 碧兰麻的无痛治疗率在前牙为100％、前磨牙为95.2％、上磨牙为87.5％、下磨牙效果较差,为46.3％;而利多卡因的无痛治疗率在前牙为88.2％、前磨牙为66.7％、上磨牙为52.9％、下磨牙为58.6％。除下颌磨牙外,两组无痛治疗率有非常显著的差异(P<0.01)。结论 碧兰麻的麻醉效果明显优于利多卡因,可作为牙髓治疗中的首选麻醉剂。     

碧兰麻用于牙髓病治疗局部麻醉的效果观察

目的:探讨碧兰麻用于麻醉牙髓时的方法及效果。方法:急性牙髓炎患牙94颗,慢性牙髓炎患牙68颗,作唇(颊)侧根尖区黏膜下浸润麻醉(单侧麻醉),观察麻醉效果;对上、下磨牙、下前磨牙设颊、舌侧麻醉组(双侧麻醉组)与上述同名牙的单侧麻醉组对照。所得结果用四格表χ2检验。结果:162颗牙髓炎患牙,单侧麻醉显效率为72.8%。麻醉效果与牙髓的急、慢性炎症状态无显著关系(P>0.05)。下磨牙作双侧麻醉,效果明显优于单侧麻醉(P<0.05)。结论:牙髓炎患牙作牙髓摘除术时,用碧兰麻作单侧麻醉具有良好的效果,建议对下磨牙作双侧麻醉。     

复方盐酸阿替卡因注射剂应用于拔牙的临床效果观察

目的：观察评价复方盐酸阿替卡因注射剂应用于临床拔牙的麻醉效果，方法：收集门诊拔牙病例530例，采用分层随机的方法将其分为3组，分别在利多卡因，普鲁卡因肾上腺素和复方盐酸阿替卡因局麻下拔牙，术后对麻醉效果的问卷结果行统计分析，对比评价这3种局麻药的麻醉结果。结果：复方盐酸阿替卡因用于拔牙的麻醉效果明显优于另外2种局麻药（P＜0．01），结论：复方盐酸阿替卡因应用于临床拔牙，具有操作简便，起效快，持续时间长，并发症少等优点，是一种较为理想的局部麻醉剂。     

碧兰麻用于牙髓镇痛临床疗效观察

以往的局麻药因注射方法、麻药毒副作用及麻药效果不理想等原因 ,给口腔医师在牙髓治疗中带来不便。作者选用碧兰麻局麻注射剂应用于牙髓治疗中 ,取得了良好的镇痛效果 ,现报告如下。1　材料与方法1.1　病例选择　选择年龄在 18～ 6 2岁患者 83例 ,全身健康情况良好 ,无局麻药过敏史。患牙为急、慢性牙髓炎需行牙髓治疗者 ,意外露髓、隐裂牙不能保髓治疗者共 86颗患牙 ,其中前牙 16颗 ,上颌前磨牙 15颗 ,上颌磨牙 2 7颗 ,下颌前磨牙 9颗 ,下颌磨牙 19颗。1.2　药物资料及给药方法1.2 .1　药物　使用法国赛特力—碧兰麻公司生产的复方盐酸阿…     

碧兰麻局部浸润麻醉致过敏l例

患者男，33岁，体质量52kg。因左侧上颌前牙夜间痛、冷刺激痛来院就诊。经检查诊断为左侧上颌前牙急件牙髓炎。患者无高血压及药物过敏史，于左侧上颌前牙唇侧及腭侧分别注射0．3、0．4m1．碧兰麻，作局部浸润麻醉。回抽无血，注射后5min，有麻小感，冷刺激无痛，进行左侧上颌前牙开髓，当拔髓时感疼痛。注射后10min，患者自述头痛剧烈，烦躁，面部潮红，牙痛。15min后，整个颈部及胸前区出现红色点状皮疹（药物疹）。     

联合麻醉在下颌阻生智齿拔除术中的临床应用

目的：比较必兰和利多卡因不同麻醉方法在下颌阻生智齿拔除手术中的麻醉效果。方法160颗下颌阻生智齿随机分为必兰局部浸润麻醉组、必兰阻滞麻醉组、利多卡因阻滞麻醉组、必兰和利多卡因联合麻醉组进行局部麻醉,行拔除手术,观察麻醉效果,并进行统计学分析。结果必兰和利多卡因联合麻醉组在下颌阻生智齿拔除术中的麻醉效果均优于必兰局部浸润麻醉组、必兰阻滞麻醉组和利多卡因阻滞麻醉组,差异均有统计学意义(P<0.05)。必兰阻滞麻醉组和利多卡因阻滞麻醉组的麻醉效果均优于必兰局部浸润麻醉组,差异均有统计学意义(P<0.05)。必兰阻滞麻醉组和利多卡因阻滞麻醉组之间的麻醉效果差异无统计学意义(P>0.05)。结论必兰和利多卡因联合麻醉用于拔除下颌阻生智齿有较好的麻醉效果,值得临床推广应用。     

Periodontal repair of periapical lesions: the borderland between pulpal and periodontal disease

A series of cases demonstrating the destruction of periapical periodontal structures, without pulpal involvement has been presented. Treatment using both surgery and antibiotics resulted in extensive healing without any concommitant endodontic therapy. The results suggest that lesions affecting the apical periodontium are either periodontal or pulpal in origin. Careful diagnosis allows the maintenance of pulp vitality in cases where apical destruction has a source other than an infected pulp. The commonly held belief that lateral and accessory canals are a significant source of pulpal contamination from deep periodontal pockets has been questioned.     

Dependence of pulpal blood-flow responses on baseline blood-flow in the cat

It has been shown earlier that electrical stimulation of the distal cut end of the inferior alveolar nerve (IAN) in the cat evokes three different patterns of pulpal blood-flow (PBF) response in the ipsilateral mandibular canine tooth (a decrease, a biphasic response, or an increase). The response to a given stimulus sometimes changed to another pattern even in one and the same experimental animal during the course of the experiment. It is known that the evoked decrease is due to activation of the sympathetics and that the increase is due to antidromic activation of sensory fibres; but, it is unknown why the response varies so much. It is hypothesised that the baseline blood-flow (BBF) modulates vasomotor responses in the dental pulp. To test this hypothesis, the effects of BBF on PBF responses elicited by the IAN stimulation mentioned above were investigated. Dynamic changes in PBF in cat mandibular canine teeth were elicited by electrical stimulation of the distal cut end of the IAN, at various BBF, with blood-flow monitored by laser Doppler flowmetry. The amplitude of the PBF vasodilator response increased as BBF was adjusted downwards (by cooling the tooth). In contrast, the amplitude of the PBF vasoconstrictor response increased as the BBF rose. Vasodilator responses could be transformed into vasoconstrictor responses, and vice versa, by alterations in the BBF. No systemic blood-pressure changes were elicited throughout the experiment. These results indicate that a consideration of baseline vascular tone is important, whenever the size of PBF responses to various stimuli is discussed or calculated.     

Effect of full crown preparation on pulpal blood flow in man

ObjectiveTo determine if full crown preparation causes an increase in pulpal blood flow (PBF), indicating inflammation, in human subjects.DesignThe experiments were carried out on 35 intact, mandibular posterior teeth in 13 subjects: 32 were abutments for 16 fixed bridges that replaced first molars; the other 3 were first premolars adjacent to abutment teeth that served as un-operated controls. Crown preparations were made using an air-rotor with water-spray under regional block anaesthesia (4% articaine with epinephrine 1:100,000). PBF was recorded with a laser Doppler flow meter (LDF) before and after administering the anaesthetic, with the LDF probe on the buccal enamel. PBF was then recorded from the abutment teeth with the probe on buccal dentine after preparing the buccal surfaces of both teeth, after completing the crown preparations, and after 1 and 7 days. PBF was also recorded from the buccal enamel of the control teeth on each occasion.ResultsThe mean ± S.D. PBF values before and after anaesthesia were 2.63 ± 2.13 and 2.42 ± 2.38P.U. respectively, which were not significantly different (Paired t-test). The mean values for the abutment teeth after buccal preparation, after complete crown preparation, and after 1 and 7 days were 5.20 ± 2.49, 4.53 ± 2.52, 4.92 ± 2.98 and 5.48 ± 2.65P.U. respectively. The 4 values for each tooth were not significantly different (two-way RM ANOVA). In the control group, the values under all six conditions were not significantly different.ConclusionsRegional block anaesthesia produced no change in PBF, nor did full-crown preparation, neither immediately after the procedure nor 1 and 7 days later.     

Effect of simulated pulpal pressure on all-in-one adhesive bond strengths to dentine

OBJECTIVES: To evaluate the durability of all-in-one adhesive systems bonded to dentine with and without simulated hydrostatic pulpal pressure (PP). METHODS: Flat dentine surfaces of extracted human molars were prepared. Two all-in-one adhesive systems, One-Up Bond F (OBF) (Tokuyama Corp., Tokyo, Japan), and Fluoro Bond Shake One (FBS) (Shofu Co., Kyoto, Japan) were applied to the dentine surfaces under either a PP of 0 or 15cm H(2)O. Then, resin composite build-ups were made. The specimens bonded under pressure were stored in 37 degrees C water for 24h, 1 and 3 months under 15cm H(2)O PP. Specimens not bonded under pressure were stored under zero PP. After storage, the specimens were sectioned into slabs that were trimmed to hourglass shapes and subjected to micro-tensile bond testing (muTBS). The data were analysed using two-way ANOVA and Holm-Sidak HSD multiple comparison tests (alpha=0.05). RESULTS: The muTBS of OBF fell significantly (p<0.05) when PP was applied during bonding and storage, regardless of storage time. In contrast, although the muTBS of OBF specimens bonded and stored without hydrostatic pressure storage fell significantly over the 3 months period, the decrease was less than half as much as specimens stored under PP. In FBS bonded specimens, although there was no significant difference between the muTBS with and without hydrostatic pulpal pressure at 24h, by 1 and 3 months of storage under PP, significant reductions were seen compared with the control group without PP. CONCLUSION: The muTBS of OBF bonded specimens was lowered more by simulated PP than by storage time; specimens bonded with FBS were not sensitive to storage time in the absence of PP, but showed lower bond strengths at 1 and 3 months in the presence of PP.     

广州市人群牙髓病的患病率及危险因素分析

目的调查广州市18～74岁城乡居民牙髓病的患病率及其危险因素。方法采用多阶段分层随机抽样方法，根据《牙体牙髓病学》（第2版）临床诊断标准检查诊断，用SPSS11．0软件统计分析获得牙髓病患病率．并进行危险因素分析。结果广州市18～74岁城乡居民牙髓病的患病率为28．42％，其中男性27．14％，女性29．82％，患病率随年龄增大呈增高趋势。患牙髓病的危险因素包括：性别、年龄、受教育程度、牙齿充填情况和牙齿修复情况。结论通过流调获得广州市人群牙髓病的患病率及其危险因素．提示牙髓病是影响我市人群口腔健康的常见多发病，提出促进牙体疾病的早期治疗、改善治疗质量和增强牙髓病的防治宣教是控制牙髓病患病率的重要措施。     

Effect of simulated pulpal pressure on self-adhesive cements bonding to dentin

OBJECTIVES: To evaluate the bonding effectiveness of self-adhesive luting cements to dentin in the presence of simulated hydrostatic intrapulpal pressure (PP). METHODS: Thirty composite overlays (Aelite All Purpose Body) were luted to deep-coronal dentin surfaces using four self-adhesive resin cements (Rely X Unicem, G-Cem, Multilink Sprint, Bis-Cem) and one total-etch system (Calibra). Half of the specimens resin cements were applied under a PP of 15 cm H2O. After storage in a moist condition for 1 month (37 degrees C, 100% relative humidity), specimens were sectioned into microtensile beams (1mm2) and stressed to failure with the microtensile bond strength test (microTBS). Data were statistically analyzed with Kruskal-Wallis ranking (p<0.05) and Mann-Whitney tests (p<0.001). The fracture pattern was evaluated under SEM. RESULTS: Bond strength of Calibra fell significantly when PP was applied during bonding (p<0.05). Rely X Unicem and Bis-Cem performed better under PP. No significant differences for Multilink Sprint and G-Cem bonded specimens were recorded with or without PP. SIGNIFICANCE: Simulated PP influences the adhesive performance of resinous cements. The predominance of acid-base reactions or radical polymerization may explain the different behavior of self-adhesive cements when changing substrate wetness. The application of constant intrapulpal perfusion should be considered when simulating luting procedures in vitro.     

Sensory experiences in relation to pulpal nerve activation of human teeth in different age groups

There are no data on the correlation of intradental nerve activity and sensation from intact human teeth. We used microneurography to examine this relation and to determine whether it changes with age. Fifteen informed and healthy male volunteers were divided into three age groups: group A (18.6±1.82 years, mean±standard deviation (S.D.)), group B (38.4±2.70 years) and group C (64.0±4.06 years). Ratings of perceived pain intensity to thermal stimulation were obtained using a visual analogue scale (VAS). In addition, each subject chose one or two words from the short-form McGill Pain Questionnaire to describe perceived pain. A total of 90 single pulpal axons were studied with microneurography at the same time as the sensory experiences were recorded. Mean conduction velocities and variance estimates correlated closely with age. With advancing age, first, the percentage of teeth from which the subjects did not perceive any sensations to thermal stimulation increased, second, units responding to heat stimulus decreased, and third, latencies of sensation induced by thermal stimulation increased. In addition, a burst of afterdischarges following thermal stimulation and neural discharges evoked by thermal stimulation produced no sensation only in some of group B and C units. In contrast, no significant difference was found among three groups in VAS scores and words to describe the perceived pain to thermal stimulation. These results suggest that pulpal afferents were activated by the same mechanism(s); the hydrodynamic mechanism works immediately after thermal stimulation and is possibly followed by direct activation of some nerves, especially slow conducting fibres. In older tooth pulps, the decrease in the number of fast conducting afferents and mineral apposition of dentinal tubules impaired the nerve activation, especially by heat, as per the hydrodynamic mechanism. Spike discharges without sensation in older individuals were suggested to be due to insufficient spatial and temporal summation and may be involved with abnormal uncomfortable sensations.     

Anesthetic efficacy of four percent articaine for pulpal anesthesia by using inferior alveolar nerve block and buccal infiltration techniques in patients with irreversible pulpitis: a prospective randomized double-blind clinical trial

Introduction

The study was designed as a randomized double-blind trial to evaluate the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine in inferior alveolar nerve block (IANB) and infiltration anesthetic techniques to anesthetize mandibular molars with irreversible pulpitis.

Methods

The study was composed of 2 test arms and 1 control arm. Subjects in the test arms received either a standard IANB or a buccal infiltration (B Infil) of 4% articaine with 1:100,000 epinephrine, whereas the subjects in the control arm received a standard IANB of 2% lidocaine with 1:100,000 epinephrine. Subject’s self-reported pain response was recorded on Heft Parker Visual Analogue Scale after local anesthetic administration during access preparation and pulp extirpation.

Results

For statistical analysis Pearson χ², Student's paired t test, 1-way analysis of variance, and Friedman tests showed no significant difference in success rates among the 3 arms of the trial.

Conclusions

Although B Infil and IANB of 4% articaine were equally effective, B Infil can be considered a viable alterative in IANB for pulpal anesthesia in mandibular molars with irreversible pulpitis.     

阿替卡因与甲哌卡因在老年人磨牙牙髓治疗中的临床效果比较

目的：比较阿替卡因和甲哌卡因在老年人口腔局部麻醉的临床效果。方法：将346例急慢性牙髓炎老年患者随机分成2组进行局部浸润麻醉,对其注射时疼痛、牙髓治疗时麻醉效果、上下颌的麻醉差异进行观察分析。结果：甲哌卡因和阿替卡因在注射时的疼痛程度无显著性差异。相同颌位时,甲哌卡因和阿替卡因的局部浸润麻醉效果无显著性差异;而在不同颌位时,甲哌卡因和阿替卡因对上颌磨牙的麻醉效果均优于下颌磨牙。结论：阿替卡因和甲哌卡因注射疼痛小,麻醉效果相似。